Allergic Rhinitis

Topic Overview

What is allergic rhinitis?

Allergic rhinitis,
often called allergies or hay fever, occurs when your
immune system overreacts to particles in the air that
you breathe—you are allergic to them. Your immune system attacks the particles
in your body, causing symptoms such as sneezing and a runny nose. The particles
are called
allergens, which simply means they can cause an
allergic reaction.

People with allergies
usually have symptoms for many years. You may have symptoms often during the
year, or just at certain times. You also may get other problems such as
sinusitis and
ear infections as a result of your allergies.

Over time, allergens may begin to affect you less, and your symptoms may
not be as severe as they had been.

What are the symptoms of allergic rhinitis?

In
most cases, when you have allergic rhinitis:

You sneeze again and again, especially after you wake up in the
morning.

You have a runny nose and
postnasal drip. The drainage from a runny nose caused
by allergies is usually clear and thin. But it may become thicker and cloudy or
yellowish if you get a nasal or sinus infection.

Your eyes are watery and itchy.

Your ears, nose, and throat are itchy.

Which allergens commonly cause allergic rhinitis?

You probably know that pollens from trees, grasses, and weeds cause
allergic rhinitis. Many people have allergies to
dust mites,
animal dander, cockroaches, and mold as well. Things
in the workplace, such as cereal grain, wood dust, chemicals, or lab animals,
can also cause allergic rhinitis.

If you are allergic to pollens,
you may have symptoms only at certain times of the year. If you are allergic to
dust mites and indoor allergens, you may have symptoms all the time.

How is allergic rhinitis diagnosed?

To find out if
you have allergies, your doctor will ask about your symptoms and examine you.
Knowing what symptoms you have, when you get them, and what makes them worse or
better can help your doctor know whether you have allergies or another
problem.

If you have severe symptoms, you may need to have allergy
tests to find out what you are allergic to.

Your doctor may do a skin test. In this test your doctor puts a
small amount of an allergen into your skin to see if it causes an allergic
reaction.

Your doctor may order lab tests. These tests look for
substances that put you at risk for allergies.

How is it treated?

There is no cure for allergic
rhinitis. One of the best things you can do is to avoid the things that cause
your allergies. You may need to clean your house often to get rid of dust,
animal dander, or molds. Or you may need to stay indoors when pollen counts are
high.

Unless you have another health problem, such as asthma, you
may take over-the-counter medicines to treat your symptoms at home. If you do
have another problem, talk to your doctor first. Others who also should talk to
their doctor before starting self-treatment include older adults, children, and
women who are pregnant or breast-feeding.

If
your allergies bother you a lot and you cannot avoid the things you are
allergic to, immunotherapy (such as allergy shots) may help prevent or reduce your symptoms. To have this treatment, you first need to know what you are allergic to.

Finding the treatment that works best for you may take a little
time.

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Cause

Allergic rhinitis, often called hay fever, occurs when your
immune system overreacts to particles in the air that
you breathe—you are allergic to them. Your immune system causes symptoms such as sneezing and a runny nose. The particles
are called
allergens, which simply means they can cause an
allergic reaction.

Several
types of allergens cause allergic rhinitis, including
pollens, mold,
dust mites,
animal dander, and cockroaches. Although polluted air
is not an allergen, it can irritate your nose and lungs. An irritated nose or
lungs may make an allergic reaction more likely when you breathe in an
allergen.

Symptoms

Symptoms of
allergic rhinitis may develop within minutes or hours after you
breathe in an allergen. The symptoms can last for days.

Symptoms that often start as soon as you breathe in an allergen include:

Sneezing over and over again, especially after you wake up in the morning.

A runny nose.

A tickle in your throat or coughing caused by postnasal drip.

Watery, itchy eyes. This may be
allergic pinkeye.

Itchy ears, nose, and throat.

Other symptoms that may take longer to appear include:

A stuffy nose, possibly with sniffing. This is the most common
symptom in children.

When symptoms may change

Your symptoms may be better or worse at different times of the year or different times in your life. For example:

If you are
allergic to
dust mites,
animal dander, or indoor mold, your symptoms may be
more severe in winter when you spend more time indoors.

If you have a pollen allergy, your
symptoms may vary based on what plants grow in your area and what season it is.

If you get pregnant, your symptoms might get worse. Allergic rhinitis can then make
asthma and
sinusitis worse.

As you grow older, allergens may affect you
less.

What Happens

The first time you are exposed to
an allergen in the air, your body's immune system may recognize the allergen as
a foreign substance. Your body reacts by making
antibodies against the allergen.

The next time you are
exposed to the allergen, the antibodies react to it. This releases histamine and
other chemicals that cause the symptoms of your allergy. This is called
sensitization. Sensitization may occur early in life.

Children who
have allergic rhinitis may become allergic to many
allergens, including
dust mites,
dander on cats and dogs, and tree and grass
pollens.

Complications

Allergic rhinitis can affect your health if you don't
treat it. If it lasts a long time, you may have
complications such as
sinusitis, plugged ears, and
ear infections. Some people with allergic
rhinitis have
sleep apnea. Some have
asthma, and researchers are looking at whether
allergic rhinitis may lead to asthma.

Allergic rhinitis
can also affect your quality of life. You may avoid seeing people, have
problems sleeping, and feel tired or grumpy. You may have trouble with
school or work.

What Increases Your Risk

You may be more likely to
have
allergic rhinitis and other allergies if:

You have a family history of allergies, especially allergic
rhinitis. A child is more likely to have an allergy if both parents have
an allergy or have the same type of allergy.

You are exposed to
dust mites,
animal dander, or other indoor
allergens.

You are exposed to pollens or molds.

When to Call a Doctor

Call your doctor if:

You have pain in the
sinus area and other symptoms of sinus infection. (Symptoms may include fever or a creamy, yellow
or green discharge from the nose.)

Your allergy symptoms get worse and you don't know why.

You are taking a prescription or
over-the-counter allergy medicine that does not help
your symptoms.

Your allergy medicine is causing side effects that bother you,
such as decreased coordination or increased drowsiness.

You have a fever or ear pain.

You have a cough or cold that lasts longer than 1 to 2
weeks.

You have severe itching of the eyes or nose.

Your allergy disturbs your life.

Who to see

You may need to see an allergy specialist (allergist), depending on your symptoms or which other treatments you may need. For example, you may need to see a specialist if your medicines are not working or cause severe side
effects or if you are thinking about getting immunotherapy (such as allergy shots).

Your doctor may refer you to an ear, nose, and throat
(ENT) specialist (also called an
otolaryngologist or otorhinolaryngologist). An ENT
specialist may be helpful if your doctor thinks you may have
nasal polyps or other obstructions in your
nose.

Exams and Tests

Your doctor can usually diagnose
allergic rhinitis by
examining you and asking you questions about your symptoms,
activities, and home. If your doctor thinks that you
have allergic rhinitis, and you don't have complications, he or she may
decide to treat your symptoms without doing lab tests. The doctor will then check your
symptoms again later.

But you may need further testing if:

You and your doctor need to find out exactly what things you are
allergic to so that you can take steps to avoid them.

Treatment is not helping your symptoms.

You have severe symptoms.

You are considering immunotherapy (such as allergy shots).

For further testing, your doctor may suggest that you have allergy tests. For example, a skin test can show how your skin reacts to an allergen. Or a blood test can measure the level of immunoglobulin E (IgE) antibodies, which your body makes in response to certain allergens.

These tests can help your doctor know whether allergic rhinitis is causing your symptoms and find the best treatment.
They can also help your doctor see if you have
complications, such as
sinusitis or
asthma.

Other tests for allergies

In most cases, you do
not need testing. But your doctor may suggest some tests to make sure that another condition is not causing your symptoms. These tests include:

Imaging tests, such as
X-rays,
CT scans, and
MRIs. These tests can show if you have a sinus infection (sinusitis), chronic
inflammation (thickening) of the sinus lining, structural defects of the nose, or, in rare cases, cancer.

Rhinoscopy or nasal endoscopy. Both of these tests look for
nasal polyps and other problems that may block the
nasal cavity.

Mucociliary clearance testing. This test looks for abnormal
cilia in people who have very thick nasal discharge. Cilia are tiny hairs on
the lining of the nasal passages. These tiny hairs beat back and forth to remove particles
from the nose. Certain rare diseases can cause problems in the cilia, which can lead
to more nasal discharge.

Treatment Overview

The main treatments for allergic rhinitis are avoiding allergens, managing symptoms with medicine and other home treatment, and, in some cases, getting immunotherapy (such as allergy shots). How often you need treatment depends on how often you have symptoms.

Avoid allergens

It is important to avoid
allergens that are causing your symptoms. By doing this, you may be able to
reduce your allergy symptoms and manage them without medicine or with fewer
medicines.

You may need to clean your house often to get rid of dust,
animal dander, or molds. Or you may need to stay indoors when pollen counts are
high.

For more information on how to avoid and control allergens,
see Home Treatment.

Manage symptoms

Taking medicines and doing other home treatments can help you manage your symptoms. For example, over-the-counter allergy medicines (such as antihistamines or decongestants) may help relieve some of your symptoms. They may come in the form of a pill, liquid, eyedrops, or nasal spray. Or your doctor may prescribe stronger types of these medicines. You can do other things at home to help your symptoms, such as cleaning your nasal passages.

Think about immunotherapy

If medicines don't help your symptoms or if they cause bad
side effects, your doctor may suggest immunotherapy. For this treatment, you get shots or use pills that have a small amount of certain allergens in them. Your body "gets used to" the allergen, so you react less to it over time. This kind of treatment may help prevent or reduce some allergy symptoms.

Treatment for children

Treatment for children who have allergic rhinitis is
much the same as for adults who have allergies. Treating children with medicine
may be more difficult because of the possible side effects. Some medicines also
may not be approved to treat children. Be safe with medicines. Read and follow all instructions on the label.

Prevention

Experts don't know how to prevent
allergic rhinitis. Being exposed to many
allergens, secondhand smoke, and air pollution can
irritate the nose and throat and may contribute to how a person develops an
allergy.

You can take steps to reduce the symptoms of allergic
rhinitis or to make symptoms less severe.

Home Treatment

Allergic rhinitis is a long-term problem. It takes time and effort to control
allergies through home treatment. But home treatment is one of the best things you can do to help your allergies.

Avoid allergens

If you can avoid or reduce your
contact with
allergens, you may be able to reduce your allergy
symptoms and manage them without medicine or with fewer medicines. Controlling
your contact with allergens and reducing your symptoms may also make it less
likely you will develop
complications such as
sinusitis. You do this by:

It is helpful to track your symptoms and how they
affect you. For example, do your symptoms keep you from sleeping, make it hard to
concentrate, or make you sleepy? Also track your allergens and how long after
exposure to them you start to have symptoms. This information will help your doctor
prevent and treat the problem. You can keep a
symptom diary(What is a PDF document?) to track this information.

Medications

Medicines are a key part of treatment for allergic rhinitis.

Over-the-counter medicine

There are many types of allergy medicines you can buy without a prescription, such as:

Prescription medicines

If
over-the-counter medicines don't work or if they cause bothersome side effects such as
drowsiness, your doctor may prescribe a stronger or different medicine for you. For example, corticosteroid nasal sprays may reduce all symptoms of allergic rhinitis. They
work well for most people. They start working
quickly, but it may be several weeks before you get the full effect.

Your doctor may suggest other medicines if these don't
work or in special cases, such as if you are pregnant. Other medicines include:

Ipratropium bromide. It can relieve a runny
nose.

Leukotriene modifiers. These can relieve a stuffy
nose, itching and sneezing, and a runny nose.

Use medicine safely

Some people begin using
over-the-counter medicines for allergic rhinitis
before they see their doctors. These medicines can work well. But people who have
other medical problems, older adults, children, women who are pregnant or
breast-feeding, and people who have more than occasional mild symptoms should see a
doctor before starting self-treatment. For example:

If you are pregnant, talk with your doctor about which allergy medicines are safe when pregnant. Some medicines might be better for you and your baby than
others. If possible, don't use medicine for
at least the first 3 months of your pregnancy.

When you treat children with medicine, know that it may be more difficult
than treating adults because of the possible side effects. Some medicines also
may not be approved for treating children. Be especially careful with antihistamines and decongestants. They may not be safe for young children, so check the label first. If you do give these medicines to a child, always follow the directions about how much to give based on the child's age and weight.

What to think about

You may want to think about
using different medicines at different times of the day. For example, during
the day it may be important to avoid the drowsiness that some antihistamines
cause. But if you are at home in the evening and this side effect is not a
concern, you can think about using a low-cost, over-the-counter antihistamine.
You may also try a combination of medicines to relieve all of your symptoms.
Talk with your doctor about which symptoms are most important for you to treat
and which medicines may work best for you.

If you don't take your
medicine, your symptoms may come back or get worse. When you give medicine to children, explain
to them why they are taking medicine and how it can help them. Also tell them what side effects may occur.

You may use medicine daily for quick
relief of symptoms that occur suddenly or are getting worse. Or you may use it
in advance if you know you may breathe an allergen. For example, if you have
severe pollen allergies, your doctor may suggest that you start using a
corticosteroid spray 1 to 2 weeks before the pollen season starts.

Surgery

Although surgery doesn't cure
allergic rhinitis, you may need it to fix a physical
defect of the nose or sinuses. Problems such as these can make allergic
rhinitis harder to treat. You and your doctor should not consider
surgery unless other treatments have failed.

Draining fluid from the middle ear (tympanotomy or myringotomy)
or inserting tubes to help the ears drain (tympanostomy). This is sometimes
done in children who have allergic rhinitis and
ear infections. To learn more about these surgeries,
see the topic
Ear Infections.

Other Treatment

Immunotherapy

If medicines can't control your
allergic rhinitis, you may think about having immunotherapy in the form of allergy shots or sublingual tablets. Allergy shots are small doses of
allergens that your doctor injects under your skin.
With sublingual immunotherapy, you dissolve a tablet under your tongue daily. Each tablet has a small amount of allergen in it. These treatments help your body "get used to" the allergen, so your body reacts less to it over time.

Allergy shots work best if you are allergic
to pollens,
animal dander, or
dust mites. Doctors use allergy shots
mainly to treat an allergy caused by one allergen or a closely related group of
them, such as grass pollens. If you are allergic to more than one
type of allergen, you may need to get shots for each type of allergen to
relieve all of your symptoms. The allergens can usually be combined into one or
two shots.

Deciding on allergy shots is a personal decision. Although expensive, allergy
shots may not cost more than the combined cost of medicine, doctor and
emergency room visits, and missed days of school or work over several years.
But you may need allergy shots for 3 to 5
years. And there is some risk of severe whole-body reactions (anaphylaxis).

Other treatments

Because allergic rhinitis can't be cured and may be frustrating to
treat, people may try
alternative treatment methods, such as homeopathy. But
most of these treatments either have not been studied or have not been proved
to work. Such treatments may be expensive. And some can be dangerous to your
health.

Talk to your doctor if you are thinking about trying a complementary or alternative therapy or if you want to know about new treatments that are being studied for allergic rhinitis.

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